10245-10255 SW WALNUT STREET .w:
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PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N'.' ].'16 5) DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGALD AANITART DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONIVEC,'TION HAS BEEN COM-
PLETED.
PERMIT' FEE PAID !! .r.:..................
........... .........TIUARD SANITARY DISTRICT
�9 R BY
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CONNECTION INSPE.^,TED ANb APPROVED
Date __ Superintendent
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goo*
Address------,--- Permit Permit No. �
Permit
Owner Connection Connection fee_
Paid by
Type of. Buildirgi _ Date connected_
Service Rate_ T .,_ Inspection fee_a_ __.�.�..
Contractor________________._ Paid by_ -Date—
Size of connection Assessment Paid
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